Search

Information, Communication Technology (ICT) offers innovative ways for healthcare organisations to increase access to quality healthcare delivery and to ensure proficient administration of healthcare resources. The ICT policy initiative in the Ghana Ministry of Health supports a framework that highlights the use of emerging technology in healthcare and proper deployment of ICT to hasten the delivery of healthcare in all health facilities across the country. However, the application of ICT in most of the facilities is plagued with several challenges. This paper examines ICT needs of Ejisu government hospital in the Ashanti Region of Ghana. We collected quantitative data from 22 respondents [service providers (n=11) and patients (n=11)], conducted direct observation of hospital inventory and reviewed hospital documents. We used descriptive statistical analysis to describe the sample variables that emerged from the three themes: use of technology; opportunities for funding of health information technology; barriers and strengths of implementing ICT interventions in the facility. To calculate reliability scores, percentage and means of component variables were used. The results showed that majority of health workers engage in the use of electronic health record system, electronic medical records, health information exchange, electronic registry and internet use. Majority of the staff have used electronic medical records or electronic health records before. High ICT cost and limited infrastructure were the leading challenges faced by providers while low health literacy and high internet cost were the main barriers on the part of patients. The findings further demonstrated that willingness to learn and implement technology interventions were the major strengths for both providers and patients. The paper contributes to ICT application in a healthcare environment and recommends improvement in ICT infrastructure and education for patients and a subsidised operational cost for ICT implementation in the facility.

BackgroundShortages and maldistribution of healthcare workers persist despite efforts to increase the number of practitioners. Evidence to support policy planning and decisions is essential. The World Health Organization has proposed National Health Workforce Accounts (NHWA) to facilitate human resource information systems for effective health workforce planning and monitoring. In this study, we report on the accreditation practices for accelerated medically trained clinicians in five countries: Ethiopia, Ghana, Kenya, Malaysia, and Mongolia.MethodUsing open-ended survey responses and document review, information about accreditation practices was classified using NHWA indicators. We examined practices using this framework and further examined the extent to which the indicators were appropriate for this cadre of healthcare providers. We developed a data extraction tool and noted any indicators that were difficult to interpret in the local context.ResultsAccreditation practices in the five countries are generally aligned with the WHO indicators with some exceptions. All countries had standards for pre-service and in-service training. It was difficult to determine the extent to which social accountability and social determinants of health were explicitly part of accreditation practices as this cadre of practitioners evolved out of community health needs. Other areas of discrepancy were interprofessional education and continuing professional development.DiscussionWhile it is possible to use NHWA module 3 indicators there are disadvantages as well, at least for accelerated medically trained clinicians. There are aspects of accreditation practices that are not readily coded in the standard definitions used for the indicators. While the indicators provide detailed definitions, some invite social desirability bias and others are not as easily understood by practitioners whose roles continue to evolve and adapt to their health systems.ConclusionRegular review and revision of indicators are essential to facilitate uptake of the NHWA for planning and monitoring healthcare providers.

Background Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. Methods In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. Result Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. Conclusions PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

Aim: Disasters continue to wreck both developed and developing countries, causing high mortality and suffering and damage to local economies and also impede development. Ghana is exposed to natural hazards, and the country’s susceptibility to these disasters has increased in both frequency and complexity over the years. This requires an understanding of disaster planning and resource allocation, legitimised in stakeholders who exercise power and urgency to manage and mitigate external uncertainties and internal complexities. The study aimed to examine the exercise of power, legitimacy, and urgency of stakeholders in disaster risk management in the Accra Metropolitan Area. Study Design: Qualitative case study design involving respondents purposively selected from Accra Metropolitan Area and local communities was employed. We used in-depth interviews and desk reviews of policy documents to assess stakeholder role in disaster risk management. We analysed the data using the Interpretative Phenomenological Analysis technique based on three principles of the stakeholder theory; power, legitimacy, and urgency, to advance our discussions on stakeholder role in disaster risk management. Results: The findings show that central government exercises high effective power, which serves as a strong basis for policy decisions but low precision and low urgency in responding to disaster risk management. At the local government level, the exercise of power and urgency to act appear ineffective despite a strong policy framework to guide disaster management. In addition, the exercise of power and legitimacy role appears low in the local communities. Conversely, urgency in addressing disaster risk management appears to be high among community members. Conclusion: This study contributes to the existing literature by suggesting structural and administrative reforms to stakeholder role in the management of disasters; central government remains a dominant stakeholder; local government agencies restructured to have a definitive role and the communities maintain their demanding role to hold local government agencies accountable. These reforms will establish a sharp, clear roadmap for the future and set into motion scenario planning for unanticipated disasters.

Aim: Diabetes has been identified to cause prolonged ill health in many people living in rural communities in Ghana where access to health care delivery appears to be inadequate and of low quality due to financial constraints, limited health resources, poor road network, low literacy levels and limited access to specialist care. Individuals diagnosed with diabetes often express varied psychological and emotional imbalances. Therefore, immediate psychosocial care is needed to prevent patients living in rural areas from getting into severe depression mode and other mental health complications. Yet, understanding how people diagnosed with diabetes should react in order to prevent severe psychological implications has not been adequately explored in Ghana. This study explored the lived experiences of diabetes patients living in rural areas of the Eastern Region of Ghana with the aim of discovering the forces that determine appropriate psychosocial care for patients. Study Design: Using the Interpretative Phenomenological Analysis (IPA), 31 diabetes patients were purposively selected from four hospitals in the region, and interviewed using a semi-structured interview guide to investigate participants’ perceptions, thoughts, feelings, and experiences about the disease and how the participants own experiences could be used to construct a framework of immediate care applicable in their own social certain. Results: The study generated themes along productive and unproductive lines to demonstrate the lived experiences of diabetes patients. Psycho-emotional reactions, psychological shock and emotional outbursts constitute unproductive forces. This caused some of the patients to express suicidal ideations at the extreme point. On the other hand, individual resilience and disposition, guidance and support from care providers, family and community members constitute the productive forces that provide an appropriate framework for psychosocial care for diabetes patients. Conclusion: The study has shown the need to adequately address the psychological and emotional needs of diabetes patients to prevent extreme forms of psychological distress (anxiety and depression). The authors, therefore, recommend an integrated care model for diabetes patients’ in rural areas that encompass a psychosocial therapy built around the primary healthcare concept with the establishment of counseling units in all Primary Health Care facilities. This will offer a platform to generate personal and community actions and decisions to adequately address the immediate psychological and emotional needs of diabetes patients in rural areas.

The coronavirus disease 2019 (COVID-19) pandemic has manifested differently across the globe in terms of its sociocultural and economic impacts. The World Health Organization (WHO) developed guidelines for the effective implementation of local or national quarantine protocols to quickly detect people who have been exposed to COVID-19 and separate them from others during the disease’s incubation period. This paper examines how Ghanaians perceive and experience fear under quarantine in the various designated quarantine centres (Pentecost Community Centre and Pram-pram Convention Centre). Drawing on the interpretive inquiry lens, data were collected through phone/Skype interviews with six individuals who had been quarantined with experience to share. Interpretative Phenomenology Approach (IPA) for data analysis was used to interpret the views and experience of participants under quarantine and how that affected their well-being. Using the WHO quarantine guidelines, our analyses focused on an individual’s experience of fear under quarantine, offering an insight into what characterises their fear as well as exploring events, coping strategies and the implementation of standard quarantine protocols in the country. The results showed that the quarantine protocols aligned with the WHO guidelines, albeit with some exceptions; these omissions partly compounded the fear experienced by those who were quarantined in the various centres. The results help to reveal the specific events that led to fear. For example, the fear of being infected by others at the quarantine centres, the unknown duration of the quarantine, the potential loss of lives and the uncertainty of recovery. The participants managed their fearful experiences and tension at the quarantine centres by coming together to pray every morning, share the word of God and engage in jokes. This paper contributes to issues of distinct emotions and individual viewpoints under mandatory quarantine during the COVID-19 pandemic in a specific country context.

Background: Telemedicine has proven to be one of the modern medical discoveries in recent times, serving as a technological tool to deliver healthcare at a distance and providing medical solutions to remote communities with limited access to quality healthcare. However, the challenges associated with the use of telemedicine in Ghana make it difficult to scale up its application at the Primary Healthcare (PHC) level. Aim: The aim of the study was to assess the current trends and applications of telemedicine in health care delivery at the primary health care level in Ghana. The study also sought to identify the prospects and challenges of telemedicine implementation in Ghana. Study Design: The study employed both qualitative and quantitative design involving 200 respondents made up of 80 healthcare professionals and 120 patients from four primary healthcare facilities in the Ahafo-Ano North District of the Ashanti region of Ghana Methods: Survey questionnaire, semi-structured interview guide, and field observations were used to find out the knowledge of providers, capacity, availability of network infrastructure, and challenges of implementing telemedicine at the PHC level from the viewpoint of healthcare 'professionals' and to verify factors that can persuade patients to participate in the implementation of telemedicine. Logistic regression analysis was conducted to estimate the factors influencing 'patients' decision to participate in telemedicine, while the qualitative data were analyzed using thematic content analysis. Results: The results show that knowledge and education about telemedicine, easy access to specialist care at home, widespread use of mobile telephony, and reduction in travel cost due to telemedicine significantly influence both providers' and patients' participation in telemedicine at the primary healthcare level. The minimum educational level for patients to participate in telemedicine implementation is a primary education (OR = 0.233, p

Aim: The aim of the study was to explore nursing students’ first clinical experience with a dying patient or the dead. Study Design: The study employed a qualitative case study design involving six students, homogenous in nature and purposively selected from the nursing department of a private university in Accra. We used in-depth interviews to solicit for lived experiences of the participants and the field data were analysed using Interpretative Phenomenological Analysis technique. Results: Seven themes emerged from the analysis; reasons for choosing nursing as a profession, emotional and psychological effects, coping strategies, preparation of the student before clinical placement, access to counselling and future thoughts about nursing. Productive and unproductive forces are used to illustrate the experiences of the students. The results showed that nursing students were inadequately prepared for their first clinical practice and experienced varied negative emotional and psychological effects such as fear and stress. Some of the students were unable to cope with their experiences and as a result wanted to quit the training while others were able to accept the situation due to their personal disposition. Conclusion: The authors recommend that students should be given adequate orientation or preparation before clinical placement and where possible, counselling services should be made available to them before, during and after their clinical placement both at the hospital and in the school.

Over the past two decades, the higher education sector in Ghana has undergone many reforms ranging from deregulation and financial sustainability to massive investments in infrastructure. These reforms are aimed at addressing diversity in schools, promoting inclusive learning and increasing access to quality tertiary education. The reforms required changes in job skills, job conversions, modes of teaching and learning, self-consciousness and staff re-locations with probable consequent effect on the well-being of employees. However, these reforms failed to adequately account for employee well-being issues. Hence personal changes and support schemes to help employees keep pace with the changes have received little attention. We investigated these phenomena in public universities to understand the well-being shifts during the reforms from the storylines of higher education academic employees. The study adopted a qualitative research design using laddering interview technique grounded in the personal change theory to solicit stories from 19 academic employees who have lived across the reforms. Interpretative Phenomenology Approach (IPA) of data analyses was used to analyse the experiences of academic employees. The study provides personal stories reflected in real-life experiences and hinged on the eudemonic theory within a developing country context. The study discovered that leadership, personal mindset shifts and political interference constitute a Change-Effect Model that shapes the well-being of academic employees during the period of organisational reforms. The findings provide a new dimension to organisational reforms and employee well-being and consider from a critical viewpoint how a change-effect model can be applied in change management process to support employee well-being in locally appropriate and effective ways.

This study sought to examine the interplay between market rewards and sustainability of private nursing and midwifery colleges in a competitive market environment. Over the last two decades, there has been a proliferation of Private Nursing and Midwifery Colleges in Ghana. These colleges are increasingly competing with their counterparts in the public sector that receive incentives from government. Therefore, increasing market rewards of private nursing colleges is imperative for sustainability of the colleges. The study adopted a descriptive survey design using quantitative approach. Total number of respondent for this study was 142. The study uncovered that equal employment opportunities for graduates, tax holidays, subventions or support from government were the key market rewards that could lead to sustainability of private institutions. These rewards were found to have a significant relationship with sustainability of institutions. The study also discovered that, effective market rewards can lead to improvement in enrolment and attraction of local or external investors in management of private nursing and midwifery colleges to enable them compete with those in the public sector.

The banking sector in Ghana plays a dominant role in the financial sector, particularly with respect to mobilization of savings and the provision of credit. An analysis of bank interest rate spreads is therefore central to the understanding of the financial intermediation process and the macroeconomic environment in which banks operate. This paper is motivated by the fact that although Ghana’s financial sector was liberalized in the early 1990s to allow for market determination of interest rates, concerns about high interest rate spreads have persisted and attracted a lot of debate in both public and policy forums. The purpose of the study is to empirically investigate the interest rate spread on banks profitability in Ghana using average annual observation data from1992–2015 to include 28 commercial banks. Ordinary least square was used to estimate the regression coefficients. The empirical results show that bank-specific factors play a significant role in the determination of interest rate spreads in the Ghana’s banking sector. All the bank specific variables were found to be significant except Total Assets (TA). Among the macroeconomic variables, inflation was found to be significant whereas GDP growth rate was insignificant. The role of the global financial institutions is changing and so are the banks operating in Ghana. The banking sector should explore new paths that will enable them to take advantage of the government’s policy of making the “private sector the engine of growth” to market their products.

The mining industry has traditionally been a major recipient of foreign direct investment in sub-Saharan Africa and has commonly been an important foreign exchange earner for the region. The purpose of this study is to empirically determine the factors that have influence FDI flows in Ghana from 1983 to 2012, using co-integration analysis. The major empirical and methodological contribution of this study is the use of co-integration approach to determine FDI inflows to the mining sector in Ghana. The results of the study registered exchange rate, inflation and openness of trade to be significant in the long run. Natural resources were designated to have a negative long-run relationship between FDI inflows. GDP was used as a proxy for market size and economic liberalization were also registered to be insignificant. In the short run all the variables were found to be insignificant except natural resources which contributed negatively and significant to the mining sector. One economic task facing Ghana, therefore, is how to articulate the necessary policies that can attract the right kind of FDI in the mining sector.

Can governments in developing countries retain skilled health workers by raising public sector wages? We investigate this question using sudden, policy-induced wage variation in which the Government of Ghana restructured the pay scale for health workers employed by the government. We find that a 10% increase in wages decreases annual attrition from the public payroll by 1.0 percentage point (from a mean of 8 percentage points) among 20–35 year-old workers from professions that tend to migrate. As a result, the ten-year survival probability for these health workers increases from 0.43 to 0.49. The effects are concentrated among these young workers, and we do not detect effects for older workers or among categories of workers that do not tend to migrate. Given that Ghana was a major source of skilled health professional migrants during this period and that our attrition measure correlates strongly with aggregate migration, we interpret these results as evidence that wage increases in Ghana improved retention mainly through reducing international migration.

The study investigated the market structure of Ghana¡¯s banking industry and determined whether the market structure has been changed after the financial restructuring. This study specifically measures the degree of competition of the banking system in Ghana by using the H-statistics. Various studies on the degree of competition were reviewed. This study employs a widely used nonstructural methodology put forward by Panzar and Ross (1987) ¡ªthe H-statistic¡ªand drawn upon a comprehensive average annual data from the various issues of the Bank of Ghana annual reports from 1988 to 2011. Based on the reported H-statistic, it can be concluded that Ghana¡¯s banks are operating under perfect condition. However, the test for a change in competition status at the time of liberalization was not significant, indicating no evidence of a change in competition as a result of liberalization. This study has extended and strengthened some earlier results on bank competition in Ghana. However, the results of this study are different from the study undertaken by Buchs and Mathisen (2005), who found Ghanaian banking markets to operate under monopolistic conditions.

The West African country of Ghana is more economically and politically stable than many other African countries, but despite this stability, Ghana has dire health care needs. For its 23 million inhabitants there are approximately 2,000 doctors and 500 medical assistants. The medical assistant (MA) in Ghana is the analog of the physician assistant (PA) in the United States. The majority of physicians practice in large tertiary hospitals in the two main cities of Accra and Kumasi. For years Ghana has suffered “brain drain,” with physicians leaving the country immediately after completing their training, in search of higher wages abroad.1 As a result, the majority of physicians currently practicing in Ghana are specialists. The people living in rural and underserved areas are cared for primarily by the MAs, who provide approximately 70% of the country’s primary care. Ghana’s national vision and goal for health is to “create wealth through health,” thereby attaining middleincome status by 2015. According to officials in the Ministry of Health (MOH), the ultimate goal is to “ensure a healthy and productive population that reproduces itself safely.” This goal is being pursued on many levels and the MA is seen as playing a critical role. Thus, the focus on capacity-building for this profession is important. Training Medical Assistants in Ghana The Kintampo Rural Health Training School (KRHTS) was established in 1969 by the MOH, with the motto “Educating for Service.” Its graduates live their lives by this. The school is celebrating its 40th anniversary this year, which also marks the 40th anniversary of the MA profession in Ghana. This is a strikingly similar timeline to that of the US PA profession. The school has the mandate to turn out qualified multipurpose health personnel to provide quality health care in the country. Since its inception, the school has graduated hundreds of MAs, health information technicians, community health officers, medical laboratory technicians, community oral health officers, and community health field technicians. The focus of the school is primary health care, which is taught through the public health approach of caring for communities and populations. To date it is the only school of its kind in Ghana, and it continues to make immense contributions to the reduction of suffering, morbidity, and mortality, particularly among marginalized population groups. Recently there have been several schools going through the accreditation process to train MAs. When the profession started 40 years ago, MAs were initially trained The Global Perspectives feature focuses on global issues relevant to PA education. Appropriate topic areas include international clinical student placements, development of PA-type programs in other countries, global or immigrant health care curriculum issues, and first-person reports of international PA educational activities. Articles are typically solicited by the feature editor from individuals with direct experience in international activities. Others wishing to submit manuscripts are encouraged to obtain prior approval from the Global Perspectives feature editor. Editorials will not be accepted. Authors desiring to contribute to Global Perspectives should forward submissions to

Previous Ghanaian governments attempted to use Ghana’s well-developed banking system to grow the economy. Bad loans caused the banks to suffer great losses during the late 1980s, and decline in the cedi value caused a rise in the banks external loans. In 1988, the government initiated financial reforms to strengthen the banking sector. The reforms aimed to improve profitability, efficiency and productivity of banks. In spite of these reforms in 1990s, banks’ performance has remained poor with substantial gaps in service delivery to private agents. There is sufficient empirical evidence that poor performance is manifest in low performance of bank indicators, including: high levels of credit risk to private agents, poor quality loans, limited and or inadequate capitalization, operational inefficiencies, higher incidences of non-performing loans, higher levels of liquidity risk; among others. Empirical evidence clearly shows that studies focusing on Ghana’s financial sector are still scanty and limited. The study seeks to investigate the determinants of banks ‘profitability in Ghana for the period 1988 to 2011 using Economic Value Added (EVA) technique to measure performance. The study evaluates two performance yardsticks to determine the best alternatives. The result of the study suggested economic value added as the best measurement as against the standard accounting measurement namely; ROA. Inflation was registered not to be affected Ghana’s bank performance. The study results draw some implications for policy that helps to improve performance of the banking sector in Ghana.

The formal banking sector does not satisfy the growing demand for credit, and many borrowers turn to informal loan sources to meet their production and consumption needs. The problem of the rural credit, which includes supplying credit for a rural community for economic growth, is reemerging on the development agenda as a pressing issue. The rural economy is financially very fragile. Lack of credit is a significant and sometimes binding constraint, limiting investment in productivity-enhancing technology and inputs. Rural credit plays a critical role in household strategies to reduce vulnerability. In spite of the contribution that credit entails to the rural development, it has been one of the crucial factors that have not been given proper attention. The purpose of this paper is to identify problems that have hindered the effectiveness of the rural credit market in Ghana. The paper is premised on the theoretical understanding of rural credit markets and applies the framework to investigate the aspect of the rural credit market in Ghana. Improving the rural credit system will help to raise household incomes and reduce poverty and will contribute to the eradication of extreme poverty. The paper identifies high cost, interest rate, lack of collateral, lack of innovation and high delinquency rates as the main factors that have hindered the effectiveness of the rural credit market in Ghana. This paper will interest policymakers to place more emphasis on savings mobilization and to revisit interest rate policy, while providing cheap and adequate credit to small and poor farmers.

Foreign Direct Investment (FDI) has been viewed as a major stimulus to economic growth in developing countries. Its ability to deal with two major obstacles; namely, shortages of financial resources and technology and skills, has made it the center of attention for policymakers in low-income countries in particular. In spite of the significance generated by FDI flows, the flow to developing countries and the world, in general, has witnessed persistent decline over the years. The implication for the drop means that competition to attract FDI has increased as developing countries continue to create the enabling environment to attract foreign investors. Ghana, in particular, has, over the last decade, pursued various forms of economic reforms and liberalization of trade regimes in order to become more competitive in the international financial market. A handful of papers has recently dealt with FDI flows in Ghana. However, most of these studies are concerned with strategic FDI policy to attract FDI flows. The purpose of this study is to empirically determine the factors that influence FDI flows in Ghana, using time series data from 1988 to 2011. Regression analysis was carried out using relevant econometric techniques. The results of the study capture trade openness, exchange rate, natural resources, and infrastructure as the drivers of FDI in Ghana. Macroeconomic variables, such as inflation and per capita gross domestic products, were also registered to impact the determinants of FDI flows in Ghana. The contribution of this paper is that economic liberalization was found to be significant, indicating that policymakers' efforts in liberalizing the economic activities may necessarily translate into significant FDI inflows into the country.